Skip to main content
SpringerLink
Log in

Lower Socioeconomic Status is Associated with an Increased Incidence and Spectrum of Major Congenital Heart Disease and Associated Extracardiac Pathology

  • Research
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Several studies have suggested an inverse relationship between lower socioeconomic status (SES) and the incidence of congenital heart disease (CHD) among live births. We sought to examine this relationship further in a Canada-wide population study, exploring CHD subtypes, trends, and associated noncardiac abnormalities. Infants born in Canada (less Quebec) from 2008 to 2018 with CHD requiring intervention in the first year were identified using ICD-10 codes through the Canadian Institute for Health Information Discharge Abstract Database. Births of CHD patients were stratified by SES (census-based income quintiles) and compared against national birth proportions using X2 tests. Proportions with extracardiac defects (ED) and nonlethal genetic syndromes (GS) were also explored. From 2008 to 2018, 7711 infants born with CHD were included. The proportions of major CHD distributed across SES quintiles were 27.1%, 20.1%, 19.2%, 18.6%, and 15.0% from lowest to highest, with significant differences relative to national birth proportions (22.0%, 20.0%, 20.6%, 20.7%, and 16.7% from lowest (1) to highest (5)) (p < 0.0001). No temporal trends in the CHD proportions across SES categories were observed over the study period. The distribution across SES quintiles was different only for specific CHD subtypes (double-outlet right ventricle (n = 485, p = 0.03), hypoplastic left heart syndrome (n = 547, p = 0.006), heterotaxy (n = 224, p = 0.03), tetralogy of Fallot (n = 1007, p = 0.008), truncus arteriosus (n = 126, p < 0.0001), and ventricular septal defect (n = 1916, p < 0.0001)), with highest proportions observed in the lowest quintile. The proportion of the total population with ED but not GS was highest in lower SES quintiles (< 0.0001) commensurate with increased proportion of CHD. Our study suggests a negative association between SES and certain CHD lesions and ED.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Liu Y et al (2019) Global birth prevalence of congenital heart defects 1970–2017: updated systematic review and meta-analysis of 260 studies. Int J Epidemiol 48(2):455–463

    Article  PubMed  PubMed Central  Google Scholar 

  2. Moons P et al (2010) Temporal trends in survival to adulthood among patients born with congenital heart disease from 1970 to 1992 in Belgium. Circulation 122(22):2264–2272

    Article  PubMed  Google Scholar 

  3. Marelli AJ et al (2014) Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010. Circulation 130(9):749–756

    Article  PubMed  Google Scholar 

  4. GBD 2017 Congenital Heart Disease Collaborators (2020) Global, regional, and national burden of congenital heart disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Child Adolesc Health 4(3):185–200

    Article  Google Scholar 

  5. Yang BY et al (2021) Maternal exposure to ambient air pollution and congenital heart defects in China. Environ Int 153:106548

    Article  CAS  PubMed  Google Scholar 

  6. Ngwezi D, Hornberger L, Vargas A (2018) Environmental pollution and the development of congenital heart disease: a scoping review. Adv Pediatric Res 5:17

    Google Scholar 

  7. Ngwezi DP et al (2018) Tracking trends in emissions of developmental toxicants and potential associations with congenital heart disease in Alberta, Canada. Challenges 9(2):28

    Article  Google Scholar 

  8. Ngwezi DP et al (2018) Industrial developmental toxicants and congenital heart disease in urban and rural Alberta, Canada. Challenges 9(2):26

    Article  Google Scholar 

  9. Yu D et al (2014) Maternal socioeconomic status and the risk of congenital heart defects in offspring: a meta-analysis of 33 studies. PLoS ONE 9(10):e111056

    Article  PubMed  PubMed Central  Google Scholar 

  10. Miao Q et al (2023) Association between maternal marginalization and infants born with congenital heart disease in Ontario Canada. BMC Public Health 23:790

    Article  PubMed  PubMed Central  Google Scholar 

  11. Peyvandi S et al (2020) Environmental and socioeconomic factors influence the live-born incidence of congenital heart disease: a population-based study in California. J Am Heart Assoc 9(8):e015255

    Article  PubMed  PubMed Central  Google Scholar 

  12. Egbe A et al (2014) Changing prevalence of severe congenital heart disease: a population-based study. Pediatr Cardiol 35(7):1232–1238

    Article  PubMed  Google Scholar 

  13. Davey B et al (2021) Social determinants of health and outcomes for children and adults with congenital heart disease: a systematic review. Pediatr Res 89(2):275–294

    Article  PubMed  Google Scholar 

  14. Best KE et al (2019) Socio-economic inequalities in mortality in children with congenital heart disease: a systematic review and meta-analysis. Paediatr Perinat Epidemiol 33(4):291–309

    Article  PubMed  Google Scholar 

  15. Kuciene R, Dulskiene V (2009) Maternal socioeconomic and lifestyle factors during pregnancy and the risk of congenital heart defects. Medicina (Kaunas) 45(11):904–909

    Article  PubMed  Google Scholar 

  16. Agha MM et al (2011) Socioeconomic status and prevalence of congenital heart defects: does universal access to health care system eliminate the gap? Birth Defects Res A Clin Mol Teratol 91(12):1011–1018

    Article  CAS  PubMed  Google Scholar 

  17. Carmichael SL, Ma C, Shaw GM (2009) Socioeconomic measures, orofacial clefts, and conotruncal heart defects in California. Birth Defects Res A Clin Mol Teratol 85(10):850–857

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Adams MM, Mulinare J, Dooley K (1989) Risk factors for conotruncal cardiac defects in Atlanta. J Am Coll Cardiol 14(2):432–442

    Article  CAS  PubMed  Google Scholar 

  19. Yang J et al (2008) Socioeconomic status in relation to selected birth defects in a large multicentered US case-control study. Am J Epidemiol 167(2):145–154

    Article  CAS  PubMed  Google Scholar 

  20. Long J, Ramadhani T, Mitchell LE (2010) Epidemiology of nonsyndromic conotruncal heart defects in Texas, 1999–2004. Birth Defects Res A Clin Mol Teratol 88(11):971–979

    Article  CAS  PubMed  Google Scholar 

  21. Purkey NJ et al (2019) Birth location of infants with critical congenital heart disease in California. Pediatr Cardiol 40(2):310–318

    Article  PubMed  Google Scholar 

  22. Correa-Villaseñor A et al (1991) White-black differences in cardiovascular malformations in infancy and socioeconomic factors. The Baltimore-Washington Infant Study Group. Am J Epidemiol 134(4):393–402

    Article  PubMed  Google Scholar 

  23. Baron AM et al (2001) Congenital heart disease in the Medicaid population of Southern Arizona. Am J Cardiol 88(4):462–465

    Article  CAS  PubMed  Google Scholar 

  24. Kaur A, Hornberger L, Fruitman D, Ngwezi DP, Eckersley L (2022) Impact of location of residence and socioeconomic status on prenatal detection of congenital heart disease in a jurisdiction of universal health coverage. Ultrasound Odstet Gynecol 60:359

    Article  CAS  Google Scholar 

  25. Bennett S, Eckersley L, Kaur A, Fruitman D, Hornberger LK (2022) Impact of socioeconomic status and remoteness of residence on fetal outcomes in major CHD. J Am Coll Cardiol 79(9):1971

    Article  Google Scholar 

  26. Krishnan A et al (2021) Impact of socioeconomic status, race and ethnicity, and geography on prenatal detection of hypoplastic left heart syndrome and transposition of the great arteries. Circulation 143(21):2049–2060

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kaur A et al (2022) Trends in the prenatal detection of major congenital heart disease in Alberta from 2008–2018. J Obstet Gynaecol Can 44(8):895–900

    Article  PubMed  Google Scholar 

  28. Rivera LA, Lebenbaum M, Rosella LC (2015) The influence of socioeconomic status on future risk for developing Type 2 diabetes in the Canadian population between 2011 and 2022: differential associations by sex. Int J Equity Health 14:101

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ospina M et al (2020) Socioeconomic gradients of adverse birth outcomes and related maternal factors in rural and urban Alberta, Canada: a concentration index approach. BMJ Open 10(1):e033296

    Article  PubMed  PubMed Central  Google Scholar 

  30. Persson M et al (2019) Maternal overweight and obesity and risk of congenital heart defects. J Am Coll Cardiol 73(1):44–53

    Article  PubMed  Google Scholar 

  31. McLaren L (2007) Socioeconomic status and obesity. Epidemiol Rev 29:29–48

    Article  PubMed  Google Scholar 

  32. Janssen I et al (2006) Influence of individual- and area-level measures of socioeconomic status on obesity, unhealthy eating, and physical inactivity in Canadian adolescents. Am J Clin Nutr 83(1):139–145

    Article  CAS  PubMed  Google Scholar 

  33. Helle E, Priest JR (2020) Maternal obesity and diabetes mellitus as risk factors for congenital heart disease in the offspring. J Am Heart Assoc 9(8):e011541

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Chou FS, Chakradhar R, Ghimire LV (2021) Socioeconomic and racial disparities in the prevalence of congenital heart disease in infants of diabetic mothers. J Matern Fetal Neonatal Med 34(24):4167–4170

    Article  PubMed  Google Scholar 

  35. Siahpush M et al (2006) Socioeconomic variations in nicotine dependence, self-efficacy, and intention to quit across four countries: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control 15(Suppl 3):iii71–iii75

    PubMed  PubMed Central  Google Scholar 

  36. Malik S et al (2008) Maternal smoking and congenital heart defects. Pediatrics 121(4):e810–e816

    Article  PubMed  Google Scholar 

  37. Carmichael SL et al (2007) Maternal food insecurity is associated with increased risk of certain birth defects. J Nutr 137(9):2087–2092

    Article  CAS  PubMed  Google Scholar 

  38. Qu Y et al (2021) Maternal folic acid supplementation mediates the associations between maternal socioeconomic status and congenital heart diseases in offspring. Prev Med 143:106319

    Article  PubMed  Google Scholar 

  39. Sotres-Alvarez D et al (2013) Maternal dietary patterns are associated with risk of neural tube and congenital heart defects. Am J Epidemiol 177(11):1279–1288

    Article  PubMed  PubMed Central  Google Scholar 

  40. Ou Y et al (2016) Risk factors of different congenital heart defects in Guangdong. China Pediatr Res 79(4):549–558

    Article  PubMed  Google Scholar 

  41. Olugbuyi O et al (2022) Impact of socioeconomic status and residence distance on infant heart disease outcomes in Canada. J Am Heart Assoc 11(18):e026627

    Article  PubMed  PubMed Central  Google Scholar 

  42. Luo ZC, Wilkins R, Kramer MS (2006) Effect of neighbourhood income and maternal education on birth outcomes: a population-based study. CMAJ 174(10):1415–1420

    Article  PubMed  PubMed Central  Google Scholar 

  43. McCrindle BW et al (1996) An increased incidence of total anomalous pulmonary venous drainage among aboriginal Canadians. Can J Cardiol 12(1):81–85

    CAS  PubMed  Google Scholar 

  44. Sharma AK et al (2020) Assessing childhood health outcome inequalities with area-based socioeconomic measures: a retrospective cross-sectional study using Manitoba population data. Pediatr Res 88(3):496–502

    Article  PubMed  Google Scholar 

Download references

Funding

The study was funded as part of Dr. Kaul’s Heart and Stroke Foundation Chair. The Foundation had no input into the design, analysis, or interpretation.

Author information

Author notes

  1. Christopher Smith and Oluwayomi Olugbuyi have contributed equally as co-first authors.

Authors and Affiliations

  1. School of Public Health, University of Alberta, Edmonton, Canada

    Christopher Smith & Padma Kaul

  2. Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada

    Christopher Smith, Padma Kaul, Douglas C. Dover & Sunjidatul Islam

  3. Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada

    Oluwayomi Olugbuyi, Andrew S. Mackie, Luke Eckersley & Lisa K. Hornberger

  4. Department of Medicine, University of Alberta, Edmonton, Canada

    Padma Kaul

  5. Department of Obstetrics & Gynecology, Women & Children’s Health Research Institute, University of Alberta, Edmonton, Canada

    Lisa K. Hornberger

  6. Pediatric Cardiology, Stollery Children’s Hospital, 4C2, 8440 112th Street, Edmonton, AB, T6G 2B7, Canada

    Lisa K. Hornberger

Authors
  1. Christopher Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Oluwayomi Olugbuyi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Padma Kaul
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Douglas C. Dover
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrew S. Mackie
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sunjidatul Islam
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luke Eckersley
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lisa K. Hornberger
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CS (graduate student) and YO (clinical pediatric cardiology trainee) were co first authors who drove all aspects of the research, generating a proposal outlining plans for the research, generating the data from the administrative dataset, performing statistical analyses and generating the manuscript. PK (epidemiologist and research scientist) and LKH (clinical and research pediatric cardiologist) were co-senior supervising faculty who initiated and assisted the first authors in developing the study, overseeing data acquisition, mining, analyses and interpretation and generating the manuscript at every step. LKH is the submitting and corresponding author. DD (senior analyst) and SI (g=postdoctoral student) mined and collected the CIHI data, and assisted both CS and YO data analysis and interpretation. They also reviewed and provided input into the manuscript. DD also generated the final figures and tables with CS and reviewed the statistical analyses for accuracy. AM and LE are pediatric cardiologists who have assisted the development of this project, initially part of the scholarship oversight committee of Dr Olugbuyi, made important contributions to refining the data requested and ultimately collected, reviewed analyses and were important in the interpretation of data, assisted with critical review of the manuscript and input. All authors reviewed, contributed to and approved of the manuscript.

Corresponding author

Correspondence to Lisa K. Hornberger.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest relevant to this article to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smith, C., Olugbuyi, O., Kaul, P. et al. Lower Socioeconomic Status is Associated with an Increased Incidence and Spectrum of Major Congenital Heart Disease and Associated Extracardiac Pathology. Pediatr Cardiol 45, 433–440 (2024). https://doi.org/10.1007/s00246-023-03310-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-023-03310-x

Keywords

Search

Navigation